Angioplastia primaria con trombectomía versus angioplastia primaria convencional en pacientes con infarto agudo del miocardio con elevación del segmento s-t. Hospital José Carrasco Arteaga. Cuenca, 2009- 2016

Abstract

BACKGROUND During primary angioplasty (PA) in patients with ST-segment elevation myocardial infarction (STEMI), intracoronary thrombi may embolize into the microcirculation and increase the size of infarction, a phenomenon that can be reduced by thrombectomy, however recent studies have not shown improvement in coronary reperfusion and major clinical events, so its routine use is controversial.

METHOD A sample of 206 patients with STEMI from the registry of the Ecuadorian Institute of Social Security, 107 in the PA with thrombectomy group and 99 in the PA conventional group, were included. The objective was to compare coronary reperfusion (ST-segment resolution, final TIMI 3 flow, no reflow and recovery of the left ventricular ejection fraction) and major clinical events (cardiac death, non-cardiac death, perforation, stent thrombosis, stroke, major bleeding, reinfarction, cardiogenic shock, emergency revascularization, NYHA 4 heart failure) at 30 days. During the analysis we used chi squared, analysis of variance, relative risk and confidence interval (CI) 95% and a level of significance <0.05. RESULTS The ST-segment resolution ocurred in 29.9% of patients in the PA with thrombectomy group versus 43.3% in the PA conventional group (RR 0.68, 95% CI: 0.47-0.99, P: 0 , 04). Death from cardiac causes ocurred in 4.7% of patients in the AP with thrombectomy group versus 13.1% in the PA conventional group (RR 0.35, 95% CI: 0.13 - 0.96 P: 0.032). The other parameters of reperfusion and major clinical events did not have difference. CONCLUSIONS Thrombectomy was not associated with improvement in coronary reperfusion however it decreased cardiac death.